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General NPI Number Information
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NPI Number | 1306143680
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Entity Type | Individual
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Provider Name | HUDSON GRAY WILKINS MA, LPCC
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Gender | Male
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Dates
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Enumeration Date | 02/22/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2627 REDWING RD STE 342
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City | FORT COLLINS
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State | CO
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Zip | 80526-6321
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Country | US
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Telephone | 615-243-0874
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | TIMNATH
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State | CO
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Zip | 80547-0331
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Country | US
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Telephone | 615-243-0874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC.0015720
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License Number State | CO
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